| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,283 |
1,227 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
2,459 |
2,359 |
$43K |
| D0330 |
Panoramic radiographic image |
988 |
926 |
$42K |
| D1120 |
Prophylaxis - child |
1,471 |
1,416 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,191 |
2,108 |
$31K |
| D0274 |
Bitewings - four radiographic images |
845 |
802 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
256 |
199 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
298 |
247 |
$18K |
| D0272 |
Bitewings - two radiographic images |
928 |
890 |
$16K |
| D1206 |
Topical application of fluoride varnish |
528 |
497 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
141 |
139 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
153 |
148 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
61 |
28 |
$619.50 |